MEDICARE: CONSTANCE YABLONSKI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1457418162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE YABLONSKI LCSW

Provider Business Mailing Address
First Line	:	6038 N NEWBURG AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-2602
Country	:	US
Telephone Number	:	773-775-5313
Fax Number	:

Provider Business Practice Location Address
First Line	:	6321 N AVONDALE AVE STE A101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1900
Country	:	US
Telephone Number	:	773-774-7555
Fax Number	:	773-774-8910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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